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NPI Code Detail

MEDICARE: EYE GROUP, LLC

MEDICARE: EYE GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier
2207W00000XOphthalmology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4CQ2384OTHERARRALIROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
25B728OTHERARBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366414187
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE GROUP, LLC
Provider Business Mailing Address
First Line : 7901 DALLAS ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4281
Country : US
Telephone Number : 479-782-8892
Fax Number : 479-782-8840
Provider Business Practice Location Address
First Line : 7901 DALLAS STREET
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4281
Country : US
Telephone Number : 479-782-8892
Fax Number : 479-782-8840
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROBERT B KNOX
Credential : M.D.
Telephone Number : 479-782-8892
Provider Enumeration Date : 02/06/2006
Last Update Date : 04/27/2018

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Directions to “EYE GROUP, LLC ” Practice Location

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